Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Nicotine may predispose to kidney injury by increasing the oxidative stress, and there is known association between smoking and the progression of chronic kidney disease, including IgA nephropathy. Currently, there is no information about the influence of smoking on the presentation of IgA vasculitis (IgAV) in adults. The aim of our study was to evaluate the role of smoking on the clinical manifestations of acute adult IgA vasculitis.
Methods: We analyzed medical records of histologically proven, adult IgAV cases, diagnosed between January, 1 2010 and April, 30 2017 at our at our secondary/tertiary rheumatology center. The disease activity was assessed using Birmingham vasculitis activity score-3 (BVAS-3). Renal disease was defined severe in case of nephrotic syndrome or nephritic syndrome with acute renal failure. Gastrointestinal (GI) disease was severe in case of bloody diarrhoea, ileus or bowel perforation. We looked at the potential differences in the clinical manifestations of acute IgAV with regard to smoking habits at the time of IgAV presentation (nonsmokers vs. ever smokers vs. current smokers).
Results: During the 76 month period we identified 207 new IgAV cases (56.5 % males, median (IQR) age 64.6 (44.6; 77.3) years). Skin, GI, renal and joint involvement were present in 207 (generalized purpura above the waist in 102 and necrotic in 98), 68 (severe in 17), 94 (severe in 23), and 87 patients, respectively. 87 patients (42.0%) had a positive history of smoking, and 38 of them were current smokers, smoking daily on average (SD) 13 (± 8) cigarettes (range 1 to 30).
Clinical characteristics of nonsmokers vs. ever vs. current smokers are presented in the Table 1. There were no significant differences regarding the frequency of overall GI tract, renal or joint involvement between the groups. However, current smokers had 4.5 times higher risk of clinically severe renal involvement vs. nonsmokers (95%CI 1.8 – 11.0; p=0.001). Past smokers developed severe renal involvement as frequent as nonsmokers (p= 0.202)
Conclusion: Current smoking was associated with the clinically more severe kidney involvement in adult IgAV. This increased risk disappeared with smoking cessation.
Table 1.
|
Clinical characteristics |
Nonsmokers (120) |
Ever smokers (87) |
Current smokers (38) |
|
Male gender |
44.2 |
73.6 |
65.8 |
|
Age (years)* |
69.2 (41.4;80.6) |
62.0 (49.5;74.9) |
50.3 (39.6;64.2) |
|
Disease duration (days)* |
10 (5;21) |
8 (5;14) |
9(5;16) |
|
Prior infection (%) |
35.8 |
34.5 |
44.7 |
|
Generalized purpura |
48.3 |
50.6 |
47.4 |
|
Skin necroses (%) |
46.7 |
48.3 |
52.6 |
|
Joint involvement (%) |
40.8 |
43.7 |
52.6 |
|
Arthritis (%) |
15.0 |
18.4 |
21.1 |
|
GI tract involvement (%) |
32.5 |
33.3 |
39.5 |
|
Severe GI tract involvement (%) |
7.5 |
9.2 |
13.2 |
|
Renal involvement (%) |
41.7 |
50.6 |
57.9 |
|
Severe renal involvement (%) |
5.8 |
18.4 |
26.3 |
|
IgA level (g/l)* |
3.7 (3.0;4.8) |
4.5 (3.1; 5.7) |
3.9 (2.9;5.2) |
|
BVAS-3 |
8 (3;14) |
9 (4;16) |
12 (5;17) |
Legend: * median and IQR; severe GI tract involvement – bloody diarrhea or ileus or surgical intervention; severe renal involvement – acute renal failure or nephrotic syndrome; BVAS-3 – Birmingham vasculitis activity score;
To cite this abstract in AMA style:
Hočevar A, Rotar Z, Jurcic V, Tomšič M. Is Smoking Important in Adult IgA Vasculitis? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/is-smoking-important-in-adult-iga-vasculitis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-smoking-important-in-adult-iga-vasculitis/